Open Forum: San Francisco’s war against the mentally ill

Staff members at the Zuckerberg San Francisco General Hospital's adult residential facility at a rally at the Behavioral Health Center at 887 Potrero Avenue on August 22, 2019 in San Francisco, CA. The hospital's former chief of psychiatry, Robert Okin, argues that San Francisco's cuts to mental illness services over the past several years add up to a war on mentally ill people.

Photo: Lea Suzuki / The Chronicle

Last month’s violent attack on San Francisco resident Paneez Kosarian, allegedly by a homeless, mentally ill man in front of her condo building on the Embarcadero, has touched a nerve in the city. This is largely due to the public’s sympathy with the victim, against the backdrop of San Francisco’s tepid and often destructive response to the crisis of homelessness.

• It allowed the Sutter Hospital system to eliminate all psychiatric beds at St. Luke’s in 2005 and a 20-bed psychiatric unit at its Davies campus in 2009. Meanwhile, the new hospitals on Geary and Van Ness and on Cesar Chavez and Valencia have no plans to include psychiatric beds.

• It’s slashed the number of subacute beds for mentally ill people with chronic disorders who need longer-term medical and nursing care.

• It’s allowed the number of beds in board-and-care homes, the residential facilities serving the severely mentally ill, to wither by 50% over the past 20 years.

• It sat on its hands while the conservator’s office lost staff and largely relinquished much of its responsibility for supervising a group of mentally ill people who don’t need to be locked up but need help and guidance to remain stable.

• While Mayor London Breed is sympathetic toward people with mental illness, she spoke out against Proposition C, which was designed to fund the creation of thousands of housing and shelter beds for homeless mentally ill people.

Finally, there’s the mayor’s recent plan to cannibalize the Adult Residential Facility at General Hospital by eliminating 41 long-term treatment beds in favor of short-term shelter beds. One of the arguments that she used was that there were empty beds at that facility, but she failed to explain that the reason they are empty is because of the city’s failure to staff them.

There have been some positive actions, including City Hall’s action to create housing units for mentally ill people. But these initiatives have been grossly insufficient, given the size of the problem and the growth of this population. Given the overall picture of city government’s actions over the past two decades, we can only conclude that San Francisco has been at war against the mentally ill.

I recognize that this problem is complex, but it will never be solved unless the mayor augments her goodwill with strong leadership. She must insist that her departments address the needs of these patients with clear plans, action steps, dates, and a transparent and public report card setting forth the progress (or lack thereof) for which each department is responsible.

At the very least, the city should restore beds in acute, subacute and board-and-care facilities; bring the conservator’s office back to life; and develop detailed plans to implement the supported housing measures set forth in Proposition C so that implementation can begin as soon as the spurious legal challenges against it are exhausted.

Most San Francisco residents have not actually inured themselves to the human suffering they pass on the streets every day. They don’t want to feel either fear or misery, and they’ve already shown at the ballot box that they want adequate funding for this population. Reversing these cuts would be a victory for every resident of this city.

Robert Okin is the former chief of psychiatry at Zuckerberg San Francisco General Hospital and professor emeritus of psychiatry at UCSF School of Medicine. He is the author of “Silent Voices: People with Mental Disorders on the Street.”